多州医疗机构相关性感染的时点患病率调查。
Multistate point-prevalence survey of health care-associated infections.
机构信息
From the Centers for Disease Control and Prevention (S.S.M., J.R.E., L.M.-H., S.K.F.) and Emory University School of Medicine (S.M.R.) - both in Atlanta; Colorado Department of Public Health and Environment, Denver (W.B.); Oregon Public Health Authority, Portland (Z.G.B.); New York-Rochester Emerging Infections Program and University of Rochester, Rochester (G.D.); Tennessee Department of Health, Nashville (M.A.K.); Minnesota Department of Health, St. Paul (R.L.); Connecticut Department of Public Health, Hartford (M.M.); California Emerging Infections Program, Oakland (J.N.); Georgia Emerging Infections Program and the Atlanta Veterans Affairs Medical Center, Decatur (S.M.R.); New Mexico Department of Health, Santa Fe (D.L.T.); and Maryland Department of Health and Mental Hygiene, Baltimore (L.E.W.).
出版信息
N Engl J Med. 2014 Mar 27;370(13):1198-208. doi: 10.1056/NEJMoa1306801.
BACKGROUND
Currently, no single U.S. surveillance system can provide estimates of the burden of all types of health care-associated infections across acute care patient populations. We conducted a prevalence survey in 10 geographically diverse states to determine the prevalence of health care-associated infections in acute care hospitals and generate updated estimates of the national burden of such infections.
METHODS
We defined health care-associated infections with the use of National Healthcare Safety Network criteria. One-day surveys of randomly selected inpatients were performed in participating hospitals. Hospital personnel collected demographic and limited clinical data. Trained data collectors reviewed medical records retrospectively to identify health care-associated infections active at the time of the survey. Survey data and 2010 Nationwide Inpatient Sample data, stratified according to patient age and length of hospital stay, were used to estimate the total numbers of health care-associated infections and of inpatients with such infections in U.S. acute care hospitals in 2011.
RESULTS
Surveys were conducted in 183 hospitals. Of 11,282 patients, 452 had 1 or more health care-associated infections (4.0%; 95% confidence interval, 3.7 to 4.4). Of 504 such infections, the most common types were pneumonia (21.8%), surgical-site infections (21.8%), and gastrointestinal infections (17.1%). Clostridium difficile was the most commonly reported pathogen (causing 12.1% of health care-associated infections). Device-associated infections (i.e., central-catheter-associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia), which have traditionally been the focus of programs to prevent health care-associated infections, accounted for 25.6% of such infections. We estimated that there were 648,000 patients with 721,800 health care-associated infections in U.S. acute care hospitals in 2011.
CONCLUSIONS
Results of this multistate prevalence survey of health care-associated infections indicate that public health surveillance and prevention activities should continue to address C. difficile infections. As device- and procedure-associated infections decrease, consideration should be given to expanding surveillance and prevention activities to include other health care-associated infections.
背景
目前，没有任何一个美国监测系统可以针对急性病患者人群中所有类型的医源性感染提供负担估计。我们在 10 个地理分布不同的州开展了一项现患率调查，以确定急性病医院中医源性感染的现患率，并对这些感染的全国负担进行更新的估计。
方法
我们使用国家医疗保健安全网络标准来定义医源性感染。在参与调查的医院中，对随机选择的住院患者进行为期 1 天的调查。医院工作人员收集人口统计学和有限的临床数据。经过培训的数据收集员回顾性地查阅病历，以确定在调查时处于活动状态的医源性感染。利用调查数据和根据患者年龄和住院时间分层的 2010 年全国住院患者样本数据，估计 2011 年美国急性病医院中所有医源性感染和感染住院患者的总数。
结果
我们在 183 家医院开展了调查。在 11282 例患者中，452 例患者发生 1 种或多种医源性感染（4.0%；95%置信区间，3.7%至 4.4%）。在 504 例感染中，最常见的类型为肺炎（21.8%）、手术部位感染（21.8%）和胃肠道感染（17.1%）。艰难梭菌是最常报告的病原体（导致 12.1%的医源性感染）。器械相关感染（即中心静脉导管相关血流感染、导尿管相关尿路感染和呼吸机相关性肺炎）一直是预防医源性感染计划的重点，占此类感染的 25.6%。我们估计，2011 年美国急性病医院中有 648000 例患者发生 721800 例医源性感染。
结论
这项医源性感染多州现患率调查的结果表明，公共卫生监测和预防活动应继续解决艰难梭菌感染问题。随着器械相关和程序相关感染的减少，应考虑扩大监测和预防活动，将其他医源性感染包括在内。
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